Request for a Release of Information
This is not a Release of Information. This is a request to our office to provide you with a Release of Information.
Please fill out the following form, and our office will generate a Release of Information for you and send it to your through our HIPPA compliant messaging system, KLARA, within two business days. Once you have received this Release of Information, you must review it, initial it and sign it where appropriate, and send it back to our office through KLARA. We will then fax out your request to the appropriate individual or office.